The role of paracetamol in chronic noncancer pain
There is evidence that paracetamol has limited efficacy in chronic noncancer pain. Despite this, a short-term trial may be considered for children or adults who are struggling to achieve a supported self-management approach. Due to the mechanism of action, paracetamol should only be trialled if a nociceptive component is suspected to be contributing to the pain; paracetamol should not be trialled in neuropathic or nociplastic chronic pain conditions. Paracetamol should be trialled before an NSAID for chronic pain with a nociceptive component because of its favourable safety profile in therapeutic doses.
If paracetamol is appropriate for adults with chronic noncancer pain, use:
1 paracetamol immediate-release 1 g orally, 4-to 6-hourly. Maximum 4 g in 24 hours chronic noncancer pain (adults) paracetamol
OR
1 paracetamol modified-release 1.33 g orally, 8-hourly. Maximum 4 g in 24 hours. paracetamol
If paracetamol is appropriate for children with chronic noncancer pain, use:
paracetamol immediate-release 15 mg/kg (for overweight children, use ideal body weight) up to 1 g orally, 4-to 6-hourly if required. Maximum 60 mg/kg up to 4 g in 24 hours. chronic noncancer pain (children) paracetamol
Advise patients (or parents/carers) to stop paracetamol after 1 week if no pain relief has occurred and to consult the prescriber for other management strategies. If paracetamol has provided adequate pain relief, advise the patient (or parent/carer) to consult the prescriber for a comprehensive assessment of analgesic efficacy and management goals after 4 weeks. If it is appropriate to continue paracetamol (eg for an underlying pathology), trial deprescribing every 3 to 6 months to assess ongoing efficacy attributable to paracetamol.